Part 3
NEVERTHELESS I greatly respect Hippocrates, and all the authors who have treated of this art. Some thanks are due to them, though but from those whom they have set to work in our days. Consider but the most celebrated authors among them down to our times, there may be found in them great progresses by degrees, especially in our modern writers on this subject. Yet the most intelligent of them feel and confess that the matter is yet far from exhausted. For after having studied all the treatises we have upon it, there may, there must be perceived an aberration and emptiness with which the understanding remains unsatisfied, and feels that much is yet wanting to the requisite perfection.
NOTWITHSTANDING likewise the veneration confessedly due to Hippocrates, I cannot dispense myself from saying the truth; he might be and doubtless was an excellent physician: he has wrote upon all the female disorders, and on the means of delivering them; he may have been consulted in his time, but he can never pass for an able man-midwife. His writings contain some violent remedies and strange prescriptions for women in labor, which must be the produce of the most dangerous ignorance of what is proper for them in that condition.
THIS author was also evidently ignorant of what concerns preternatural deliveries, as indeed were his successors till the beginning of the last century.
TO prove what I advance, there needs no recourse back to very remote times: it will be sufficient to peruse the treatises of Ambrose Paræus, Jacques Guillemeau, Peter-Paul Bienassis, printed 1602, and even that of De la Motte, who is of this century, to own, that the practice of the men-midwives was far from having attained any degree of perfection.
THE manner in which the antients proceeded, when the child presented in an untoward situation, is a fully convincing proof thereof; since they obstinately, in such cases, continued their efforts to reduce it to its natural situation, in spite of a thousand difficulties and dangers, instead of bringing it away footling, as is now done by all who understand the right practice.
HIPPOCRATES is the first who discovered that wonderful secret of killing the child, and bringing it away piece-meal from the mother’s womb. He advises it, in the manner taken notice of by Dr. Smellie, in his introduction, (page 10. & seq.) I do not know whether it is from that branch of practice that he adopts him for “the father of midwifery” (p. 4.) but, what is certain is, that Galen, and all the successors of Hippocrates, till towards the end of the last century, exactly followed his method of not delivering women in hard labors, but by the means of murderous instruments. I shall not here detain myself with rehearsing the long legend Mr. Smellie gives us of all the authors who have written on this subject to the time of Ambrose Paræus; time when to the progresses made by the midwives of the Hôtel Dieu at Paris in the art of midwifery, it was owing, that the surgeons, guided by their superior lights, made some greater progress towards perfection.
THAT the reader however may not suspect me of exaggeration, or over-straining points, I request of him to suspend his judgment, to have the patience to hear me out to the end, and he will find, that I have here advanced nothing but what in the sequel stands clearly and manifestly proved.
OBJECTION the Fourth.
IN a word, the manual operation of midwifery is an art, a science, and as such consequently more competently to be professed by men, than by women. It is making the art cheap, say the moderns, to allow the practice of it to women.
ANSWER.
I AGREE with you in the first part of your objection: but I absolutely deny the consequences.
THERE are women, who, besides the gifts received from nature, are improved by study, by reading, and experience, who succeed much more easily than men in the practice. To say the truth, nature has, in this point, been even lavish to the women, for this art is a gift innate to them.
I WILL however own, that not all women indistinctly are proper for this business; that there must be natural dispositions cultivated by art; that a purely speculative knowledge is not sufficient; that there are required good intellects, memory, strength of body and mind, sentiments, some taste, and practice joined to theory; so that when I say that the women are born with dispositions for this art; this can only be understood in general, and relatively to the men, among whom those dispositions are more rare, because they are less natural to them in this branch.
WOULD it not be a sort of blasphemy against the divine providence to maintain, that what God has placed and left in possession of the women, was fitter for the men? the attentive, beneficent, and tender manner with which he governed his people elect, obliges us to believe that he omitted nothing of what was necessary or advantageous to it; since he regarded that people as his own particular dominion and appendage; honoring it with his presence, like a master in his dwelling-house, or a father in his family. He had taken pleasure in the forming and instructing it from its infancy. He put the women in possession of the art of midwifery, he blessed, approved, and recompenced the midwives. It is but just, that men should hear and keep silence where God speaks. They may think themselves happy, to learn from him the true secrets of nature, and not from those pretended doctors who abandon the rules of truth to cleave to themselves; who, instead of her, present us with a phantom of their own creation, who, in short, would make us the worshippers of their dreams and imaginations.
THE women have for them the authority of God, who has declared himself in their favor; they have for them the authority of men from one pole to the other, who have in all ages made use of the female ministry in this art. Such a plurality of votes has surely some claim to prevalence, especially, since it is founded upon the natural order of things, upon truth and reason supported by experience. This experience we have on our side: none can deny it, without denying self-evidence.
ONE would think there is a kind of curse attends the operations of men-practitioners, as I dare aver it for a truth, that difficult and fatal labors have never been so rife, or so frequent, as since the intermeddling of the men. Whereas, God has ever so blessed the work of the midwives, that never were lyings-in so happily conducted, nor so successful, as when the practice was entirely in their hands.
OPEN the book of Numbers, you will observe, that God having ordered Moses to number his people: out of seventy individuals of the family of Jacob, who had come to dwell in Egypt, two hundred and forty years before, there had issued above six hundred thousand men fit to carry arms, without taking into the account an almost infinite multitude of children, of youths under twenty years of age, of women, of old men, besides a whole tribe, that of Levi, which was entirely set apart for the divine worship.
OBJECTION the Fifth.
THERE is no such thing as being a good practitioner of midwifery without understanding anatomy: now this science is the province of a man, of a physician, or surgeon, not of a woman.
ANSWER.
IT is sufficient that a woman understands and knows the structure and mechanical disposition of the internal parts which more particularly distinguish her sex; that she can discern the container from the contents, what belongs to the mother from what belongs to the child, as well as what is foreign to both. In short, she ought to be skilled enough to give full satisfaction to all questions that the most able anatomist could put to her, in respect to that part purely necessary to the art of midwifery, and to its operations with mastery and safety.
NOW the midwife, especially one instructed in hospitals, ought to be well acquainted with all that is essential and necessary to that effect; and she cannot but be so, unless she is of herself incapable, or that those who are charged with the instruction of pupils, wrong the confidence of the public.
I MYSELF know more than one midwife, so well educated as to be able to give demonstrations on this subject, to analyze things by their names, either upon drawings of them, upon skeletons, or upon the originals themselves. It is true, that these poor midwives do not understand anatomy enough to make dissections; but I fancy that the ladies who want assistence in their lyings-in, are not very curious of having one that can dissect instead of delivering them.
PROPHANE history has preserved to us the names and talents of a number of illustrious women who have distinguished themselves in all kinds of arts. Cleopatra queen of Egypt, is one of the first ladies that have written on the art of midwifery. Mr. Smellie, in his introduction, endeavours to render doubtful this quality of queen and princess, with a design, probably to weaken the credit of it, or rather out of contempt to the women; but as all those who have made collections of antient history, assure us, that notwithstanding the wars in which this princess was engaged, she did not neglect an assiduous application to physic, I had rather adhere to their authority, than to that of Mr. Smellie.
IN Greece, Aspasia, and a number of other celebrated women, quoted by various authors, have applied themselves to our profession, and have left behind them valuable works on the method of delivering women, and of managing them both before and after their lying-in.
MADAM Justin, midwife to the Electress of Brandenbourg, has also given us a very good treatise. Several professed midwives appointed to form the apprentices of the Hôtel Dieu at Paris, have written very clearly on the same subject, without however being mistresses of any more anatomy, than what was sufficient for their business.
OBJECTION the Sixth.
THE different instruments which the men have invented in aid of, and supplement to the deficiency of nature, and of which they are frequently obliged to make use in different labors, ought not to be put into the hands of midwives: and were it but for this reason alone, they ought to be excluded from the practice of this art. As, why multiply attendants unnecessarily? A man-midwife, with his instruments which he ought always to have about him, is enough for every thing: whereas a midwife, if the case requires instruments, will be obliged to have recourse to a man: consequently double embarrassment, double expence.
ANSWER.
THE keen instrumentarians bring an argument they imagine capable of banishing or exterminating all the midwives. The men, they say, enjoy alone the glorious privilege of using instruments, in order, as they pretend, to assist nature. But let them, I intreat of them, answer, whether if the question could be decided by votes, where is the kingdom, where is the nation, where is the town, where, in short, is the person that would prefer iron and steel to a hand of flesh, tender, soft, duly supple, dextrous, and trusting to its own feelings for what it is about: a hand that has no need of recourse to such an extremity as the use of instruments, always blind, dangerous, and especially for ever useless?
WHAT has engaged men to invent and bequeath to their successors so many wonderful productions, for such they imagine them? Is it not the thirst of fame and money? These gentry have judged, that they ought to spare no lucubrations, no labor of the head, no efforts of the tongue and pen to procure themselves a strange reputation, supported by these horrible instruments. But these lucubrations, this labor of the head, would have been much better employed in seeking for the means of absolutely doing without them, as our good female practitioners have ever done, and as those of them still do, who are instructed in the right practice.
WE are no longer in the times of the Pharaohs and the Herods, who mercilessly massacred the innocents; we are no longer in the times of those pure Arabs, who were the inventors of a number of cruel operations, and of several instruments, which often cause more apprehension and terror to a woman in labor, though concealed from her light, but never from her imagination, than the actual presence of all the apparatus of the rack, where that torture is in use.
IT were to be wished, that all the men-midwives, who had wrote on this matter, had suppressed the mention of their instruments; for as their books often fall into the hands of women, so deeply interested as the sex is in that subject, it is not to be imagined what bad effects they have. Their variations among themselves would be sufficient to frighten the women: you meet with authors condemning in the morning the over-night’s sentiment. I can observe them losing their way in systematical errors, which explain nothing to me, and in which nothing can be discovered but disagreement with one another, and with themselves. The wisest and most able of them, after having well examined all the kinds of instruments hitherto invented, have doubtless seen and been convinced of their ridiculousness and usefulness, but all of them have not hitherto dared to speak out and say as much.
THE most interested of them would fain persuade us, that, in their display of a whole armory of instruments, they have discovered the philosopher’s stone of midwifery, in virtue of which they have a right to wrest out of the women’s hands, the practice of an art, which nature has appropriated to them. But certainly the point, and the whole point is, to find an expert dexterous hand, the sex is out of the question, provided it is but a human hand, and provided the work is done to the satisfaction of society, it seems to me that nothing more need be required.
OBJECTION the Seventh.
IT is only for the ignorant to be so rash as to raise an out-cry against the use of all instruments; people who do not know the absolute necessity there is for employing them on certain occasions. This clamor must proceed “from the interested views of some low, obscure and illiterate practitioners, both male and female, who think that they find their account in decrying the practice of their neighbours.” Such is the objection in the words of Dr. Smellie, in his Treatise on Midwifery (page 241.) and for this panegyric, he prepares us in his Introduction (page 55.) where, speaking of the midwives of the Hôtel Dieu of Paris, he first indeed tells us, that the surgeons had, in that hospital, perfected themselves in the art of midwifery; but then for fear that from thence occasion might be taken of saying, that to women it was they were beholden for that perfection; he takes care immediately after to add, that what “got the better of those ridiculous prejudices which the fair sex had used to entertain,” was, that the women or midwives of this hospital “had recourse to the assistance of men in all difficult cases of midwifery.”
ANSWER.
THESE gentlemen will permit me to tell them that they make great pretentions, and prove little or rather nothing. Calling hard names with a disdainful tone, and with airs of triumph, are not overwhelming reasons.
BUT to the point. Those who reject instruments, say you, do not know what they are: they reject them from ignorance. This is soon said. Nevertheless a number of authors, much more experienced and versed in the matter than Dr. Smellie, are of this opinion. Deventer exclaims against instruments; Viardel does the same; Levret admits none but those of his own invention, and rejects universally all others; and well might he except his own, since he wrote only to recommend them. Delamotte was not very fond of instruments: he tells us in his preface, that in a course of thirty years practice, he had not twice made use of the crotchet, though he had an extent of country forty leagues round, in which he regularly exercised his profession, insomuch as to have four lyings-in in a day under his management.
I HAVE very exactly read almost all the modern authors who have written on this art; and have been surprized to observe that whilst, on one hand, they agree, they own, that in England, France, and Holland, people are much come off, or undeceived, as to all those dangerous or mortal instruments of which the antients made use, such as the short broad-bladed knife, (call it, if you please, a pen-knife) the bistory, the crotchets, &c. especially since the invention of the new forceps, or tire-tête: on the other hand, these same doctors tell you, that recourse must be had to crotchets, or to the Cæsarean operation, when the new forceps will not do. A comfortable resource this, in an instrument so boasted as the best discovery that has been made since the creation of the world, and for which we are indebted to the moderns!
I HAVE also scrupulously examined all that authors have been pleased to say of great, wonderful and magnificent, with regard to the new forceps of Palfin, as it now stands after infinite corrections, as well in foreign countries, as in this one, which have dignified it with the name of the English forceps; and I find all these great elogiums reduced, at the most, to no more than the proving, as clear as the sun, that it is allowable for an operator, extremely able and extremely prudent, to make use of it, when the business might be perfectly well done without it.
FROM thence I deduce my demonstration directly opposite to the pretentions of Dr. Smellie and of his followers. According to the instrumentarians, and according to certain doctors, there are certain occasions, certain cases, in which there is an absolute necessity for employing the forceps. If we will hearken to and follow other doctors of more celebrity and credit, it is not right to make use of it, but when one may very well do without it: for example, after the having obviated all the obstacles which retard the delivery, after having, with the hands only, dis-engaged the head or the shoulders of the child, without which (say these same writers) the instrument would be found insufficient or useless; this palpably implies the being able to do without it. Now since it is not allowable, in good practice, to make use of it, but when it is perfectly needless to use it at all, there is then no absolute necessity for it; as surely, what can be done without, is not absolutely necessary. Be this only transiently remarked. For I reserve most convincingly to prove this proposition in the second part of this work. There I shall treat of all the instruments of our antients and our moderns, and besides an enumeration of them shall demonstrate their danger and uselessness. In the mean time, it must be owned, that either Mr. Smellie has been much misinformed of what passes at the Hôtel Dieu of Paris, in the ward of the lying-in women, or else, which I the least believe, is not sincere in the account he gives us, that the women of that hospital “had recourse to the assistence of men, in all the difficult cases of midwifery;” which, he observes, “got the better of those ridiculous prejudices the fair sex had been used to entertain.” That is to say, in preference of midwives to men-practitioners.
I FREQUENTED this Hôtel Dieu two whole years, before being received an apprentice-midwife, which I accomplished with great difficulty, on account of being born a subject of England, and consequently a foreigner there: my admission, however, I gained at length, through the favor, protection, and special recommendation of his royal highness the duke of Orleans. Now, I dare aver, that in all the time before, and after I was admitted there, I never but once saw Mr. Boudou, surgeon-major called, who did nothing more than to make us, one after another, _touch_ the patient, about whom we had been embarrassed; and as he interrogated, he made us discover an _uterus_ full of schirrous callosities, which joined to its obliquities, impeded the palpation of it properly with the hand, the orifice being very difficult to come at. Every thing, however, was done without his help, and very successfully. And most certainly we should have spared him the trouble of coming at all into our ward, if the head-midwife, who was a little capricious in her temper, had not taken it into her head to keep us in our perplexity, which engaged us to send for Mr. Boudou without her knowledge, and for which she was afterwards heartily angry with us.
I NEVER once saw an occasion in which there was any necessity for using instruments, though in my time we had, at least, five or six hundred women a month to deliver.
VERY far then are the midwives from having often occasion of recourse to the assistence of the men, in difficult cases; and indeed to those prejudiced in favor of men-practitioners, it may, though true, appear strange, that in a place where there are every year so many thousand women delivered, and consequently many difficult labors amongst them, and even cases of monsters, there is no recourse to the surgeon-major but in the last occurence, which falls out very rarely.
ABOUT eighteen or twenty years ago, Madam Poor, head-midwife of this hospital, delivered a woman of a monster with two heads, with no help but only her fingers and a young prentice. Not an instrument was employed: no man assisted her. The child was christened, and died presently after. The mother remained some months upon recovery, and did perfectly well. This fact requires no proofs, being of such public notoriety. The monster was carried to St. Cosmo’s, where any surgeon may see it. I served my time with this same mistress some years after this kind of prodigy had happened.
AS to what I have advanced concerning the procedure in the wards of the lying-in women, should my testimony appear in the least suspicious, I appeal to the justice and veracity of all the doctors in England, who have been at the Hôtel Dieu at Paris, who cannot but confirm what I have said. In the mean time Mr. De la Motte, who passes for an author of credit may certify, the same. Here follows what he says in his preface to his observations, page 2.
“ONE would think (says this author) from reading the books of Messieurs Mauriceau and Peu, that it was impossible to succeed in the practice of midwifery, without having operated at Paris in the lying-in ward of the Hôtel Dieu. It is true, that this hospital is the best school in Europe, and that I would have ardently wished to have been admitted to the operations of midwifery during the five years I staid in that hospital: but as there is no more than _one_ surgeon _only_, who is in charge to attend when he is called to consultation with the midwives, and that it is a place which goes only by favor, I was forced to content myself with following in quality of topical surgeon, to the physicians who performed their visits there. So that I followed only, for six months, three physicians in their rounds there, during which time I applied myself to examine the conduct observed by those gentlemen, to preserve the women after their lying-in from the accidents which follow thereon. By this means I made myself amends for my want of recommendation; but I can safely say, that during the six months I was admitted in the above-mentioned quality, there was no more than one extraordinary labor, which was that of a child engaged in the passage, where the presence of a surgeon was required, and which however was terminated without any other help than that of patience. And yet there were (so far back as then) from three hundred and fifty, to four hundred pregnant women, who were all delivered by the apprentices and rarely by the Dame De la Marche, at that time, head midwife of the hospital: so that I am persuaded, that those who boast of having lain a great many women there, exaggerate furiously.”